Mental Health Education and Support at School can be Critical

A Brief Overview

  • Approximately one in five youth experience a mental illness before age 25. About half of those with diagnosed conditions drop out of school.
  • Suicide kills two Washington students each week.
  • These outcomes make adolescence a critical time for mental health promotion, early identification and intervention.
  • A mom in Graham, WA, launched a program to improve education about mental health after her son died by suicide in 2010. The Jordan Binion Project has trained about 500 Washington teachers with an evidence-based curriculum from Teen Mental Health.
  • Emotional Disturbance is a federal category of disability under the Individuals with Disabilities Education Act (IDEA). A student might qualify for an Individualized Education Program (IEP) under this category, regardless of academic ability. To qualify, a disabling condition must significantly impact access to learning. An educational evaluation also must show a need for specialized instruction.
  • Parents can share these resources with school staff, who may be seeking more information about how to help youth struggling to maintain their mental health.

Full Article

The thousands of young people who send thank-you letters to Deb Binion didn’t always believe their lives were going to work out. One writer had attempted suicide and been hospitalized many times because of her bipolar disorder. Two years after finishing high school, she reported she was doing well and offered thanks for a course in mental health that helped her understand her illness, its impacts on her brain, and how to participate in her treatment. “It made a total difference in my life,” she said in her thank-you letter.

“Until she got the educational piece and understood her illness, nothing was helping,” Binion says. “No one had ever explained to her why she had this illness and what was occurring.”

The program, which Binion started after her son Jordan’s suicide in 2010, has trained about 500 school staff throughout Washington State to help young people understand mental illness and what to do to support themselves and others. Although the numbers are difficult to track, Binion estimates that about 100,000 Washington students receive education through the curriculum each year.

“My mission is to get this information to the kids,” says Binion, who runs the non-profit Jordan Binion Project from her home in Graham, WA. She says a short-term, limited pilot project with the Office of Superintendent of Public Instruction (OSPI) showed promising results, with 60 teachers throughout Washington informally reporting that about 85 percent of students showed improvement in their “mental health literacy,” a key feature of the program.

Teachers are specially trained to provide the Mental Health Curriculum

The curriculum, available through TeenMentalHealth.org, was developed by a world-renowned adolescent psychiatrist and researcher, Stan Kutcher. He observed that classrooms often struggle to provide an emotionally safe learning environment for students with psychiatric conditions. Some attempts to provide education about mental health have created confusing and triggering circumstances for students impacted by illness and/or trauma, he found.

Kutcher, professor of psychiatry at Dalhousie University in Nova Scotia, Canada, responded with a model for training school staff in how to teach sensitive topics of mental illness:

  • eating disorders
  • anxiety/depression
  • attention deficit hyperactivity disorder (ADHD)
  • obsessive-compulsive disorder (OCD)
  • bipolar disorder
  • schizophrenia
  • post-traumatic stress disorder (PTSD)
  • suicidal thinking

Deb Binion says the program was designed for students in grades 9-10, but middle-school and older students are also learning from it.  She says the program takes about 8-12 hours to teach and that teachers in regular health classes, psychology classes, family and consumer science classes and others have taught the lessons.

Binion suggest that staff receive in-person training to understand how to create a safe learning environment for students. For example, teachers learn to provide individualized help without disclosing a student’s disability or medical condition to the class.

The topics can be confusing or triggering to some learners. Some of the videos might be difficult to watch because they include personal stories of self-harm, hospitalization and people suffering from emotional stress. The program may need individualized modifications for students in special education programs because of intellectual or developmental disabilities.

For information about how to bring a training to your area, individuals can contact Deb Binion through the Jordan Binion Project website or directly through her email: deborah@jordanbinionproject.org.

Washington State recognizes a need for more education and direct support

OSPI, which oversees all school districts in Washington, provides an overview of Kutcher’s work and its connection to the Jordan Binion Project as part of the Mental Health & High School Curriculum Guide. Content in the guide was a collaboration between Kutcher and the Canadian Mental Health Association. At Dalhousie University in Nova Scotia, Kutcher serves as Sun Life Financial Chair in Adolescent Mental Health and Director of the World Health Organization Collaborating Center in Mental Health Training and Policy Development.

Washington State is aware that a lack of mental health services is impacting students. Last year OSPI released data that two children enrolled in Washington schools die by suicide weekly.

According to a 2016 Washington Healthy Youth Survey, about 15 percent of teens in the state report that they have made a suicide plan. About the same percentage report that they don’t have adults to turn to when they feel depressed or anxious. The survey asked about sadness and hopelessness and whether the feelings could interrupt life for at least two weeks. About a third of the teenagers responded yes. The Centers for Disease Control reports that rates of completed suicide are rising in every region.

 

Two charts with the title, Students Experiencing Significant Mental Health Issues: 2016 Healthy Youth Survey Data

An OSPI survey in 2018 found that the number one concern statewide is that students don’t receive enough direct support in mental health, counseling and advising. Lawmakers are addressing a variety of bills during the 2019 legislative session related to mental healthcare and education. The public can contact lawmakers to participate in advocacy, and PAVE’s Washington Parent Training and Information Facebook page provides updates about some state actions that may impact families and students.

The Teen Mental Health website cites an international statistic that 1 in 5 youth experience a mental illness before age 25. Many of those illnesses lead to life challenges that require help, the agency concludes, and this makes adolescence a critical time for mental health promotion, prevention, early identification, and intervention. The agency provides a School-Based Pathway Through Care that promotes linkages between schools and healthcare agencies, parent involvement and strong educational programs that reduce stigma through knowledge and timely treatment access.

One way that Washington State has responded to the crisis is through promotion of trainings in Youth Mental Health First Aid. Through Project AWARE (Advancing Wellness and Resilience in Education) and other initiatives, Washington has grown a network of about 100 trainers for Youth Mental Health First Aid and about 4,000 first aid providers. These trained individuals can listen actively in order to offer immediate caring and can also refer youth to providers. OSPI reports that Project AWARE has led to 3,964 referrals for youth to connect with community- or school-based mental health services.  

Washington has a program for treatment response for youth experiencing psychosis. The New Journeys Program is designed for youth 15-25 who are early in their diagnoses, but there is some flexibility in who might be eligible to participate. Families can contact the program for additional information about how to apply.

Information about psychosis, early warning signs and places to seek help are available through the website of the Washington Health Care Authority (HCA). The website contains a link to information about the Wraparound with Intensive Services program (WISe), which provides community case management for children and youth experiencing a high-level of impact from a mental illness.

Special Education is one pathway toward more help

Students access some aspects of mental health support through the special education system. Emotional Disturbance is a federal category of disability under the Individuals with Disabilities Education Act (IDEA). In Washington State, the category is referred to as Emotional Behavior Disability (EBD). The IEP might list any set of these words or the initials EBD or ED.

A student might qualify for an Individualized Education Program (IEP) under this category, regardless of academic ability. A comprehensive educational evaluation can determine whether a student’s mental condition causes a significant disruption to the student’s ability to access school and learning and whether the student needs specialized instruction. Generally, that specialized instruction is provided through a category of education known as Social Emotional Learning (SEL). SEL can be provided in multiple tiers that might include schoolwide education, small group training and individualized programming. OSPI provides recommendations from a 2016 Social Emotional Learning Benchmarks Workgroup.

A student with a mental health condition also might qualify for an IEP under the category of Other Health Impairment (OHI), which can capture needs related to anxiety, ADHD, Tourette’s Syndrome or another specific diagnosis. Students with a mental health condition that co-occurs with another disability might qualify under another category, and Social Emotional Learning might be an aspect of a more comprehensive program. PAVE’s articles about the IDEA and the IEP provide further information about IEP process, the 14 categories of qualifying disabilities and access to special education services. A student with a mental health condition who doesn’t qualify for an IEP might qualify for a Section 504 plan.

If a student, because of a disability, is not accessing school and learning, then the school district holds the responsibility for appropriately evaluating that student and determining the level of support needed to provide access to a Free Appropriate Public Education (FAPE). Questions about FAPE might arise if a student with a mental health condition is not accessing school because of “school refusal,” which sometimes leads to truancy, or because a student is being disciplined a lot. Students with identified disabilities have protections in the disciplinary process; PAVE provides an article about school discipline.

Help NOW can mean a lifetime of better opportunities

The Center for Parent Information and Resources (ParentCenterHub.org) has a variety of resources related to mental health awareness, including a link to a video that details results from a national study. The study showed that students who qualified for special education programming because of Emotional Disturbance experienced the highest drop-out rates when they went into higher education, work and vocational programs. Meaningful relationships with adults who cared about them in school provided a significant protective factor. Students were more likely to succeed in life-after-high-school plans if specific caring adults provided a soft hand-off into whatever came next after graduation.

Here are a few additional resources:

  • NBC featured the Binion family and the work of their foundation.
  • OSPI provides schools with resources related to mental health education, including information related to suicide awareness and prevention.
  • PAVE provides a 40-minute webinar about suicide awareness.
  • The state currently is considering a bill to improve funding for counseling services and other bills that would boost education around mental health.
  • PAVE provides additional information about Social Emotional Learning (SEL) and state actions related to SEL programming and staff development in a series of three articles.
  • A federal agency called the Child Mind Institute provides parents with guidance about getting good mental-health care for their children and has articles on specific diagnoses and what parents and schools might do.
  • For 1:1 assistance, families can reach out to PAVE’s Parent Training and Information Center through our online Help Request Form or by calling 800-572-7368.

Here are some articles specifically about Bipolar Disorder in Youth:

Accommodations for Students with Bipolar Disorder and Related Disabilities

Educating the Child with Bipolar

Bipolar & Seasons: Fall Brings More Than Just a Change in Colors

 

Social Emotional Learning, Part 3: Tools for Regulation and Resiliency

A Brief Overview

Behavior is a form of communication. So-called “bad” behavior might mean that a child doesn’t know how to cope with an overwhelming, confusing situation.

Research shows that children who are taught self-regulation learn better at school. This article describes a few practical tools and techniques to help children manage their emotions and provides links and resources where you can find out more.

Children who attend schools that make positive behavior supports a priority get disciplined and suspended less often.

See PAVE’s Part 1 and Part 2 articles about Social Emotional Learning (SEL), with more information about the importance of compassionate schools and trauma-informed instruction.

Full Article

When a child throws a chair, kicks, screams or intentionally hits his head, what does the teacher do? The answer depends on the discipline policies of the school, but many districts are turning away from traditional punishments and toward trauma-informed techniques. These new methods of “restorative discipline” or “positive behavior interventions” are helping children maintain dignity as they recover from poor choices and learn self-regulation.

Heather T. Forbes, author of Help for Billy, is among professionals who are designing new ways to help children cope and learn. Emotional instruction is crucial, argues Forbes, whose website, Beyond Consequences, shares this advice:

“It is in the moments when your child or student is most ‘raw’ and the most dysregulated [out of control] that you are being presented with an opportunity to create change and healing. It takes interacting from not just a new perspective but from an entirely new paradigm centered in the heart.”

Forbes’ work is part of an emerging conversation about how “bad” (or unexpected) behavior can create teachable moments. Research shows that struggling children often don’t improve their behavior because of traditional punishments or even rewards.  In an article, Teaching Trauma in the Classroom, Forbes concludes:

“These children’s issues are not behavioral. They are regulatory. Working at the level of regulation, relationship, and emotional safety addresses more deeply critical forces within these children that go far beyond the exchanges of language, choices, stars and sticker charts.”

This area of education is now referred to as Social Emotional Learning (SEL). Washington school staff can access training and information about SEL through the website of the Office of Superintendent of Public Instruction (OSPI), the agency that oversees the state’s school districts. In the fall of 2018 OSPI released the Social-Emotional Learning Module. All staff—from teachers and principals to bus drivers and lunch servers—can use the training to help students learn self-awareness, self-management, social-awareness, relationships, and responsible decision-making.

OSPI offers other tools as part of its ongoing Compassionate Schools Initiative. A free e-book, The Heart of Learning and Teaching: Compassion, Resiliency, and Academic Success, includes this comment from Ray Wolpow, a project collaborator from Western Washington University:

“You cannot teach the mind until you reach the heart.”

Unexpected Behavior Can be a Cry for Help

Trauma and how it impacts learning and life has been studied since the late 1990s, when the national Centers for Disease Control and Prevention coined the term Adverse Childhood Experience (ACE). Childhood trauma was recognized as an important factor in physical and mental health conditions. In 2000, Congress established the National Child Traumatic Stress Network to offer free online courses and toolkits with continuing education credits for teachers. Among the offerings: “psychological first aid.”

This approach includes Positive Behavior Interventions and Supports (PBIS)—sometimes called PBI or PBS. A 2016 Mental Health Report from the Child Mind Institute describes PBIS as part of an array of programs that serve students from general education through special education. Educators call this type of multi-part programming a Multi-Tiered System of Supports (MTSS). PBIS can fit into MTSS programming this way:

  • Tier 1: All students and classrooms participate. These “universal interventions” integrate academics, discipline and social/emotional skill-building schoolwide.
  • Tier 2: Students who are “at risk” get more targeted interventions.
  • Tier 3: Students with significant academic, behavioral or emotional problems are supported uniquely through their Individualized Education Programs (IEPs).

According to the research, about 17,000 schools (17 percent of US schools), have PBIS. Children in PBIS schools were 33 percent less likely to receive office discipline reports and were suspended 10 percent less often than children in non-PBIS schools. The universal, school-wide interventions had significant positive effects on:

  • Disruptive behaviors
  • Concentration
  • Emotional regulation
  • Prosocial behavior

Despite these positive outcomes, the report identifies a need for more outreach and development in the third tier, related to IEP supports. According to Child Mind, more than 77,000 children who qualify for special education are suspended or expelled for more than 10 cumulative days in any given school year. Children with emotional disturbance are the most likely to be disciplined, with children who struggle with autism, anxiety and learning disorders also high on the list.

Many schools want to do better, and new supports are informed by brain science. Chapter One in OSPI’s handbook, “The Heart of Learning,” includes a list of the brain regions affected by trauma. Understanding the amygdala as a center for fear, for example, can be critical for designing strategies to manage melt-downs. “Overstimulation of the amygdala…activates fear centers in the brain and results in behaviors consistent with anxiety, hyperarousal and hypervigilance,” the page informs.

The George Lucas Educational Foundation sponsors a website called Edutopia that also offers articles that teach about neuroscience. A contributing editor on the website, Rebecca Alber, recommends that teachers “get curious, not furious” when children act out:

“When we ask students to do high-level tasks, such as problem solving or design thinking, it’s nearly impossible if they are in a triggered state of fight, flight, or freeze. This trauma state may look like defiance or anger, and we may perceive this refusal as choice, but it is not necessarily so.”

Use Your Words

Some teachers are turning directly to scientists for advice. Dan Siegel, a well-known neurobiologist and author, offers tips through his agency, Mindsight. Mindsight teaches how to “name and tame” emotions to keep from getting overwhelmed. For example, Siegel suggests learning the difference between these two sentences:

  1. I am sad.
  2. I feel sad.

The first statement “is a kind of limited self-definition,” Siegel argues, while the second statement “suggests the ability to recognize and acknowledge a feeling, without being consumed by it.”

Word choice can be critical in trauma-informed instruction. Jody McVittie, a pediatrician who started Sound Discipline, based in Seattle, gives workshops for parents and teachers. She talks about the difference between praise and encouragement in a training called Building Resiliency. Instead of saying “Great Job!” a teacher or parent might say:

  • “I noticed that you wrote all of the letters of your name on the line and it was really easy to read.”
  • “I appreciate that you asked some insightful questions during our discussion about the Constitution today.”
  • “I know you can write a creative description of the book you read.”

The more specific the encouragement, McVittie says, the more the student will be encouraged to keep working on that “good,” or expected behavior. Another of McVittie’s key concepts is “connection before correction” to help teachers create helpful relationships with students. An example she uses in her trainings:

A teenaged student tossed a soda can from across the room during class. A trauma-trained teacher pointed to the hallway, and the boy joined her there. Instead of directing him to the office, the teacher explained that she really enjoyed having him in class. She said that he contributed valuable questions. Then she asked why he thought he was in the hallway. He said it was because he threw the soda can. She asked, “What’s your plan?” His answer included apologies and decision-making about how to avoid the mistake again.

This story certainly could have ended differently, and McVittie encourages educators and parents to avoid a “Dignity Double-Bind,” where children experience shame instead of problem-solving:

“Make the child think,” she says, “by showing respect instead of giving orders to obey.”

McVittie and others hope these lessons create a new model of education where Social Emotional Learning (SEL) is part of every school day. “Let’s create a learning community,” McVittie encourages, “by showing grace.”

A Self-Regulation Strategy for Right Now

Sometimes grace starts with self-care. Following is a breathing practice you can use right now to help your nervous system regulate. You will be breathing deeply as you trace the outline of your hand, giving your eyes and your mind something to focus on while you control your breath.

  • Hold up one hand, with your palm facing you.
  • Place the first finger of your other hand onto the bottom of your thumb.
  • As you breathe in, slide your finger up to the top of your thumb.
  • Breathing out, slide your finger into the valley between your thumb and first finger.
  • Breathing in, slide up your first finger. Breathing out, slide down the other side.
  • Continue following your breath up and down all your fingers.
  • When you breathe out down the outside edge of your pinkie, continue to exhale until you reach your elbow.
  • Notice how you feel. Allow your breath to find a natural pattern.

Now that you’ve learned this technique, you can share it with your children!

The following are resources for further information and inspiration:

Resilience: The Biology of Stress and the Science of Hope, a film by KPJR
Edutopia: Getting Curious Not Furious
Beyond Consequences
Massachusetts Advocates free e-book: Helping Traumatized Children Learn
CDC ACE Report
Sound Discipline
2016 Children’s Mental Health Report
OSPI: The Heart of Learning and Teaching, Compassionate Schools
Aces Too High
The National Child Traumatic Stress Network Learning Center
The National Institute for Trauma and Loss in Children
Why Schools Need to be Trauma Informed
Center for Parent Information and Resources article bank on SEL, Behavior and School